Treprostinil (Injection)

Treprostinil is a form of medication which is used to treat pulmonary arterial hypertension.

Overview

Pulmonary arterial hypertension is a condition where there is high blood pressure in the arteries that connect the heart and the lungs. This is caused by a narrowing or blockage of the lung's arteries, which leads to the heart having to pump harder in order to transport blood into the lungs. This can cause the heart to weaken and eventually fail.

Treprostinil belongs to a group of lipid compounds known as prostaglandins, which are found naturally in the human body and affect various bodily functions. It is a vasodilator drug that helps to relax and widen the arteries to improve blood flow to the lungs. This allows for less pressure to be placed on the heart so that it can work normally. Treprostinil also inhibits the accumulation of blood platelets.

Treprostinil is taken intravenously under the brand name Remodulin. It is important that the usage of treprostinil is monitored by a doctor especially when the patient first begins using it.

The medicine is intended to help improve the patient's ability to exercise and partake in general physical activity, thereby increasing their quality of life.

Condition(s) treated

  • Pulmonary arterial hypertension

Type of medicine

  • Vasodilator

Side Effects

Not every patient will experience side effects from the medication. However it is a possibility, and a doctor usually recommends medication based on whether they feel the positive effect of the medicine will outweigh the possibilities of the side effects.

Initial use of treprostinil may cause some side effects that should disappear without treatment. These include:

  • Headaches or dizziness
  • Nausea
  • Pain in the jaw
  • Diarrhea
  • Itchy skin
  • Pain at the site of infusion

However if the above effects bother the patient or persist without any indication of stopping, the patient or their caregiver can approach their doctor or nurse with any questions they have.

Common side effects of using treprostinil can involve:

  • Swelling
  • Feeling of warmth
  • Redness of skin
  • Dizziness or feeling faint
  • Irritated, dry or hot skin
  • Hardened skin at site of injection
  • Accumulated blood at site of injection
  • Insomnia
  • Depression
  • Coughing
  • Rashes

It is advised that patients notify their doctor if they experience the above side effects for further instructions.

In the case of an overdose, the patient should seek immediate medical help. These are symptoms that they should look out for:

  • Confusion
  • Nausea
  • Vomitting
  • Dizziness or lightheadedness (especially when rising from a sitting or lying down position=
  • Blurred vision
  • Diarrhea
  • Sudden sweating
  • Feeling unusually tired or weak
  • Warmth and redness in the upper torso and arms, especially with the face and neck

The above symptoms are not a full list of effects that can happen with treprostinil. The patient or primary caregiver should monitor all and any changes with the body carefully. If any unusual symptoms and reactions occur, they should seek medical help as soon as possible.

Dosage

Treprostinil is prescribed in different amounts for different patients. Dosage also depends on the strength of the medicine prescribed. Each patient will have differing times and methods of using the medication.

Average initial dosage is about 1.25 nanograms for every kilogram of the patient's weight, per minute, for adults. The doctor will adjust the dosage as required. For children, the doctor will monitor usage and dose.

If there is a missed dose, a doctor or pharmacist must be contacted immediately for help.

Injection of treprostinil is given via a catheter, placed under the skin or into a vein. A trained medical professional is required to teach either the patient or their caregiver how to prepare the treprostinil, the catheter and the pump required to feed the medicine into the body, if the patient has been directed to continue medication at home. Initial treatment should be performed by a medical professional until otherwise instructed by a doctor.The pumps come in different models, so it is necessary to read the instructions carefully and to use them accordingly.

The patient or their caregiver should be aware of the various body parts that are suitable for infusion. They should also understand all instructions for both medication and medical devices before attempting to give an infusion. It is recommended to rotate body parts at each injection to prevent additional injury. Also, it is advisable to have an additional pump as back-up in case of any problems with the original device.

Interactions

Drugs can interact with other drugs or various substances, which may produce disruptive or even fatal results. They may also increase a risk of side effects. It is advised to keep a list of all herbal and medical products that the patient consumes, prior to and while on medication, to be shown to the doctor or pharmacist.

The doctor may prescribe other medications that lower blood pressure, similar to treprostinil. These can include other vasodilators, diuretics, blood-thinners, ACE inhibitors and calcium channel blockers. Treprostinil may cause unusual bleeding and bruising, especially when used in conjunction with blood-thinning drugs such as warfarin. If the patient notices excessive or strange bleeding and bruising, or severe dizziness or fainting, they should contact their doctor straight away for medical advice.

Do not use alcohol or tobacco with this medicine.

If there are pre-existing medical conditions, the patient should inform their physician about them prior to taking this medication. Liver and kidney disease are especially important to take note of, as it may mean a slower removal of the medicine from the body, and therefore an increase in the effects of treprostinil. Lung disease may also interact negatively with the use of treprostinil. Other conditions to take special note of are asthma, problems with bleeding, chronic obstructive pulmonary disease and hypotension.

Defibrotide is not recommended to be taken together with treprostinil. Aside from that, the following is a non-exhaustive list of medications that may cause drug interaction:

  • Aceclofenac
  • Acemetacin
  • Alipogene Tiparvovec
  • Alteplase, Recombinant
  • Amtolmetin Guacil
  • Anagrelide
  • Apixaban
  • Ardeparin
  • Argatroban
  • Aspirin
  • Bemiparin
  • Bivalirudin
  • Bromfenac
  • Bufexamac
  • Celecoxib
  • Certoparin
  • Choline Salicylate
  • Citalopram
  • Clonixin
  • Dabigatran Etexilate
  • Dalteparin
  • Danaparoid
  • Desirudin
  • Dexibuprofen
  • Dexketoprofen
  • Diclofenac
  • Diflunisal
  • Dipyridamole
  • Dipyrone
  • Droxicam
  • Edoxaban
  • Enoxaparin
  • Eptifibatide
  • Escitalopram
  • Etodolac
  • Etofenamate
  • Etoricoxib
  • Felbinac
  • Fenoprofen
  • Fepradinol
  • Feprazone
  • Floctafenine
  • Flufenamic Acid
  • Fluoxetine
  • Flurbiprofen
  • Fluvoxamine
  • Fondaparinux
  • Heparin
  • Ibuprofen
  • Indomethacin
  • Ketoprofen
  • Ketorolac
  • Lepirudin
  • Levomilnacipran
  • Lornoxicam
  • Loxoprofen
  • Lumiracoxib
  • Meclofenamate
  • Mefenamic Acid
  • Meloxicam
  • Morniflumate
  • Nabumetone
  • Nadroparin
  • Naproxen
  • Nepafenac
  • Niflumic Acid
  • Nimesulide
  • Nimesulide Beta Cyclodextrin
  • Oxaprozin
  • Oxyphenbutazone
  • Parecoxib
  • Parnaparin
  • Paroxetine
  • Phenindione
  • Phenprocoumon
  • Phenylbutazone
  • Piketoprofen
  • Piracetam
  • Piroxicam
  • Pixantrone
  • Proglumetacin
  • Propyphenazone
  • Proquazone
  • Protein C
  • Reviparin
  • Rivaroxaban
  • Rofecoxib
  • Salicylic Acid
  • Salsalate
  • Sertraline
  • Sodium Salicylate
  • Sulindac
  • Tenoxicam
  • Tiaprofenic Acid
  • Tinzaparin
  • Tolfenamic Acid
  • Tolmetin
  • Valdecoxib
  • Vilazodone
  • Vortioxetine
  • Warfarin

As it is not possible to list all drug and product interactions, patients should keep track of their consumption of any food, herbal product, supplements and medicine to show their healthcare provider if necessary. They should also take note of any unusual symptoms that occur.

Warnings

The patient's blood pressure and progress should be checked at frequent intervals by their doctor. Treprostinil may cause dizziness and lightheadedness, so it is advised that the patient should be familiar with their reaction to the medicine prior to performing any activity that requires full mental alertness such as driving or operating machinery. They should also take care to move slowly when rising from a sitting or lying down position.

Treprostinil should not be stopped without the guidance of a doctor, nor should it be stopped abruptly as it can be dangerous. It should also not be combined with any other medication, herbal products or supplements without the advice of a doctor.

Any sign of infection or reactions at the injection site should be reported as quickly as possible to their doctor. The same goes for any signs of allergy such as trouble breathing or hives.

Prior to starting treprostinil, the patient is required to tell their doctor their medical history. This includes any medical conditions in their personal or family history. They should also let their doctor know of any allergies, as treprostinil may contain inactive ingredients that can trigger allergic reactions.

The patient should also take care to notify their doctor of medical conditions and medicines they are taking if they plan to or are going into surgery.

It is unknown yet whether treprostinil is safe for people with pregnancies or who are breastfeeding as there is insufficient knowledge on whether it passes into breast milk or if it affects infants or foetuses. Patients planning on becoming pregnant or to breastfeed should let their doctor know their intentions. Currently it is not recommended to use treprostinil during pregnancy or breastfeeding.

Storage

Keep treprostinil vials in their carton, and ensure that the carton is stored away from excessive heat, moisture and direct light. Do not store in the bathroom as this may cause too much moisture to interact with the drug, and do not freeze the medication. Optimal temperatures for storage range from 20 to 25 degrees Celsius.

Do not use the medicine if the liquid in the vials has changed color, or if there are particles in it. Check the liquid before every use. The medicine can be stored for up to 30 days at room temperature after the first opening and dose.

Take medicine from the vial with a syringe and insert it into a pump. While the medicine is in the syringe, it may be used within 72 hours.

Keep out of reach of animals and children. Do not store medication that is expired, or when it is no longer needed. Dispose of them properly. Do not use syringes and needles more than once. Used needles and syringes should be disposed of in a container that cannot be punctured. If in doubt, contact a medical professional or local waste management for advice on how to best handle their disposal.

Summary

Treprostinil belongs to a class of vasodilators, which are drugs used to treat narrowing or blocked arteries. It is used to treat pulmonary arterial hypertension, which is described as high blood pressure in the arteries between the lungs and the heart, by relaxing the arteries and allowing them to widen. This in turn reduces pressure and workload on the heart, as it does not have to pump as hard to provide adequate blood flow to the lungs. They also have blood thinning properties, so patients who are on treprostinil, as well as another blood-thinning drug such as warfarin, should be alert for any unusual bleeding and bruising as that may turn dangerous.

Dosage of and treatment with treprostinil should be monitored carefully by a doctor at all times. Initial treatment of treprostinil should be carried out by a doctor, nurse or otherwise qualified medical professional. The doctor is required to check at frequent intervals on the progress of the patient. Doses can vary based on the age and weight of the patient, as well as their individual needs.

While side effects can occur, they may not always happen. Common side effects with treprostinil can include dizziness or lightheadedness, feelings of warmth and redness on the skin. It may also cause tenderness and redness at the site of the catheter. Patients using treprostinil may also experience insomnia or depression.

As treprostinil can cause dizziness and feelings of lightheadedness, patients are advised to familiarize themselves with their reactions to the medicine and refrain from any physical activity that requires mental alertness.

Prior to starting treatment with treprostinil, the patient should notify their doctor of any existing medical conditions and also of any supplements, drugs or herbal products they are consuming. This is to prevent negative interactions of the medication with other consumables. Alcohol and tobacco are especially discouraged when on treprostinil.

Patients should be careful not to stop medication abruptly as it can be dangerous. If they wish to stop treatment, they should do so under a doctor's guidance. However treprostinil can be prescribed for years to maintain the patient's health. If the patient is unsure about the length of treatment or has any questions, they should approach their doctor to discuss their issues.

Treprostinil is prescribed to help the patient breathe more easily without over-taxing their heart and to help improve their quality of life by making it easier for them to exercise.

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Last Reviewed:
December 23, 2017
Last Updated:
April 03, 2018
Content Source: